Table 3.
Barriers to and facilitators of PrEP use identified in the peer-reviewed literature and the online posts
| B/F | Theme | Peer reviewed articles | Online posts |
|---|---|---|---|
| Access | |||
| F | Doctors who are sensitive to race and poverty | – | X |
| F | Specialized roll out for marginalized populations | – | X |
| F | Trust in provider | – | X |
| F | Can get PrEP from a friend | – | X |
| F | Being able to order PrEP online and have it be delivered | – | X |
| B | Cost | X | X |
| B | Lack of access to PrEP | X | X |
| B | Not enough public education on PrEP | X | X |
| B | Too much of a hassle/difficult to attain PrEP | X | X |
| B | Insurance issues | X | X |
| B | PCP not educated enough about PrEP | X | X |
| B | Lack of knowledge of PrEP | X | X |
| B | Prescription not ready on time | – | X |
| B | Lack of access to healthcare | – | X |
| Total | 7 | 14 | |
| Attitudes/beliefs | |||
| F | PrEP decreases anxiety/stress during sexual encounters | X | X |
| F | PrEP is empowering, takes HIV protection into your own hands | X | X |
| F | Perceived high risk of contracting HIV | X | X |
| F | High degree of HIV knowledge | X | – |
| F | Being comfortable discussing HIV | X | – |
| F | Public figure/organization endorses PrEP | – | X |
| F | Condoms are also flawed | – | X |
| F | PrEP fights HIV stigma | – | X |
| F | PrEP is a viable/effective tool among others and for some people | – | X |
| B | Feeling stigmatized | X | X |
| B | Unable to talk to doctor about sex behavior | X | X |
| B | Concern about PrEP effectiveness | X | X |
| B | Satisfied with current method of HIV prevention | X | X |
| B | Distrust of pharmaceutical companies/medical system | X | X |
| B | Concern about developing drug resistant HIV strains limiting treatment options | X | X |
| B | Concern that PrEP could decrease HIV education | X | – |
| B | Concern about using a biomedical approach to HIV prevention | – | X |
| B | Perception of promoting condomless sex | – | X |
| B | Public figures/organizations anti-prep | – | X |
| B | Public has inadequate understanding of the science behind PrEP | – | X |
| B | Fear of HIV | – | X |
| B | PrEP perpetuates stigma of homosexuality and HIV | – | X |
| B | Others assume promiscuity | – | X |
| B | Less concern about HIV in current generation | – | X |
| Total | 12 | 21 | |
| Attribute of PrEP | |||
| F | Access to support services (regular HIV testing, sexual health care, counseling) | X | X |
| F | If used with condoms adds a second layer of protection against HIV | X | X |
| F | If there was an option of a non-daily dose | X | – |
| F | PrEP allows you to be sex positive | – | X |
| F | PrEP is effective | – | X |
| F | Effective even with missed doses | – | X |
| F | Well tolerated | – | X |
| F | More effective than condoms | – | X |
| F | Can use PrEP only for high risk period | – | X |
| B | Side effects of PrEP | X | X |
| B | Drug interaction | – | X |
| B | Long commitment | – | X |
| B | Doesn’t protect against other STDs | – | X |
| Total | 4 | 12 | |
| Behaviors | |||
| F | Existing practice of condomless sex | X | X |
| F | Substance use | X | X |
| F | Having many partners | X | X |
| F | Do not have to serosort partners if using PrEP | X | X |
| F | Being on a daily routine schedule/having a daily reminder | X | X |
| F | Sporadic condom use with desire for HIV protection | X | X |
| F | Having sex with both men and women | X | – |
| F | Having a prior false positive HIV test result | – | X |
| F | Can fill Rx using preferred name (not legal name) | – | X |
| B | Sexual behavior change while being on PrEP | X | X |
| B | Difficulties with adherence | X | X |
| Total | 9 | 10 | |
| Sociodemographics | |||
| F | Prior STD treatment or PEP use | X | – |
| F | Older age | X | – |
| F | High HIV prevalence in community | – | X |
| F | Being “out” | – | X |
| F | Having an occupational need for HIV protection | – | X |
| F | Preference for insertive over receptive intercourse | – | X |
| B | Higher socioeconomic status | X | – |
| B | Lack gay male identity | – | X |
| Total | 3 | 5 | |
| Social network | |||
| F | Knowing someone on PrEP | X | X |
| F | Having an HIV positive partner | X | X |
| F | Support from partner and community | X | X |
| F | Facilitates the conversation about HIV | – | X |
| F | Abusive, consent-challenged relationship | – | X |
| B | Lack of support from partner | X | – |
| Total | 4 | 5 |
B/F denotes whether the theme was determined a barrier (B) or facilitator (F). Codes are marked with an X to indicate whether they were present in the online posts or the peer-reviewed articles (or both)